Provider Demographics
NPI:1073371332
Name:CEDENO CASILLAS, TERESA (LVN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:CEDENO CASILLAS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10953 RAMONA BLVD
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-2629
Mailing Address - Country:US
Mailing Address - Phone:626-434-2521
Mailing Address - Fax:
Practice Address - Street 1:10953 RAMONA BLVD
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2629
Practice Address - Country:US
Practice Address - Phone:626-434-2521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA714539164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse